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Find out what happens when a student nurse goes to work for the first time in a neonatal intensive care unit. Daley Moore is an undergraduate student at The University of Texas at Austin School of Nursing and recently shared her experiences at Cook Children’s Medical Center in Fort Worth.

Daley Moore, an undergraduate student
at The University of Texas at Austin School of Nursing

Article and Photos by Daley Moore

This summer I spent ten weeks working as a nurse extern at Cook Children’s Medical Center in Fort Worth, Texas, in the Neonatal Intensive Care Unit (NICU). A little bit about the hospital and program before I delve into the highs and lows of my experience.

Cook Children’s has a 106-bed, Level IV NICU that offers technology such as ECMO (extracorporeal membrane oxygenation) and admits neonates as premature as 23-weeks gestational age. The externship program pairs nursing students with a nurse guide on their assigned unit who overlooks the student’s nursing care while allowing them to practice skills and work as a nurse.

Here is a bit about my experience and what I learned.

This baby is the size of my hand.

My first premature patient was born at just 26 weeks gestational age and was two weeks old on the day of my care. I started the morning as usual with my tied high pony tail, pink scrubs, coffee in hand, ready to learn more about this amazing place. I always used to think NICUs would be loud, with coding patients and hustle and bustle all around. But even now I still sometimes forget how peaceful and quiet a NICU is, with lights dimmed, the hum of a lullaby machine from a few doors down, and the now drowned out beeping of an IV or feeding pump.

I was so hesitant to reach my hands into the warm, isolated space where this tiny life resided. Hesitant to change his diaper, take his temperature, and reposition him on his tiny pillow that could morph to completely surround him.

As the weeks wore on I became more comfortable and skilled in handling premature neonates, but I never lost the caution involved in caring for a human the size of my hand. They are just the sweetest babes! They always felt like the most wonderful and exciting surprise we weren’t supposed to see yet, but somehow got a sneak peek. I never ceased to be awestruck and full of wonderment about my NICU patients and the strength and resilience of their parents.

The NICU tugs hard on my heart strings.

I have had a strong desire to work as a NICU nurse since I began nursing school, but my exposure to this intensive care unit was very brief in my pediatric clinical rotation. Therefore, I entered the externship curious to discover whether becoming a NICU nurse was the perfect fit for my personality, skill set, and future goals.

Daley with other externs

The program allowed each extern a “switch week” where we were able to switch units with another extern and work three of their shifts. I chose the Emergency Department. I discovered that I loved the high-speed and on-demand critical thinking that is necessary in an ED, especially in the trauma bay, but I also found myself continually drawn to the infants who came through the door. By the end of the week, I was so excited to get back to the tiny humans which showed me that the NICU is where I belong.

I also realized that one of my favorite aspects of nursing is making human connections which was easier to facilitate in a NICU rather than ED environment. In the ED, nurses triage, stabilize, and then send patients on their way to another floor, the operating room, or a critical care unit without being able to know the conclusion or outcome of that patient’s case. By contrast, in the NICU, some patients are there for weeks, months, or even years! If a nurse finds a patient and family they are especially drawn to, they can “primary” that family and work with them throughout their journey. This allows NICU nurses to provide higher quality and safer care since many NICU patients have complicated and complex medical histories, conditions, and medications. I realized that making that long-term connection with a family was very important to me!

I can handle babies dying.

Heading into a unit where so many babies are in critical condition had me anxious and almost certain I would lose a patient within my 10 weeks of work. I was certainly not wrong in this assumption, but I learned some valuable lessons throughout the process.

Nobody knows what to say. And there is no perfect phrase for a family who is in the process of losing their child.

In school, we learn certain ways we can provide comfort to families, and they are all useful and used in the hospital setting. But I learned that as a nurse you will always yearn to provide more comfort and support than you are able to and that’s okay! It is important to remember what not to say and continually provide your presence and allow all family members involved to express their grief, frustration, or even anger in appropriate and therapeutic ways.
Sometimes death is a relief.

There were many ethical dilemmas presented throughout my experience and it was a privilege to see parents work through the pros and cons of life and death for their ill neonates. Oftentimes, death is a relief of suffering. Other times, as nurses we simply have to respect parents’ wishes. Educating parents on the condition and severity of their infant’s illness is tantamount to ensure that families are able to make informed decisions about interventions continued or withheld.

Daley in front of Cook Children’s Medical Center

I’m emotionally stronger than I ever gave myself credit for.

I saw how the most amazing nurses made real human connections and grieved with patients and families through the ups and downs of a NICU stay. The emotional stress makes the job all the more rewarding in the end and I realized that it truly is something I can handle with the support of other nurses, health care professionals, and friends.

Neonates are the strongest humans on this planet.

My decision to become a NICU nurse has been derived from many reasons, but I couldn’t believe how inspiring these little humans were. They are given the least amount of resources, born to the world a few steps behind already, but can progress and grow into wonderful children like you wouldn’t believe.

For example, some may enter the world with conditions such as a congenital diaphragmatic hernia. This means that the diaphragm failed at keeping the intestines in the abdominal cavity, allowing them to occupy space where the lungs were meant to grow and mature in the chest cavity while in utero. This makes breathing, the most important and challenging part of life, just that much more difficult. Nevertheless, given the appropriate resources and intensive care these babies could survive. Although their feet may be little, they don’t walk alone and I was so proud every day to be given the opportunity to help them and their families accomplish their goals.

When the “why does this happen?” takes over.

The most challenging aspect of working in the NICU was the sense of powerlessness by being unable to directly and immediately prevent the conditions, situations, and systems that caused babies to be admitted to the NICU. It took daily effort to focus my energy on each of my individual patient’s goals and not become overwhelmed with desire to throw myself into promoting women’s health, preventing unwanted pregnancies, and supporting optimal maternal health. The refreshing aspect of the NICU though was that each patient is innocent and not at fault for their illness. They are itty bitty opportunities to demonstrate strength and perseverance when given limited resources.

Those who desire to become pediatric nurses are generally pretty fantastic people.

The friends I made this summer during my externship are of immeasurable value. The nurses, doctors, nurse practitioners, social workers, physical therapists, occupational therapists, respiratory therapists, and pharmacists in the NICU and ED had such huge hearts and passion for their jobs. I’m sure nurses in general are pretty great, but I might be a little partial now.

Regardless, I am happy to say that I met some truly remarkable people who tirelessly do strong work for humans who I may never know their name. It gives me great hope and confidence that I will enjoy a career as a NICU nurse for years to come.